A hepcidin‐based approach for iron therapy in hemodialysis patients: A pilot study

International audienc

Functional erythropoietin‐hepcidin axis in recombinant human erythropoietin independent haemodialysis patients

International audienceRelatively few haemodialysis (HD) patients remain independent of recombinant human erythropoietin ('rHU-EPO free patients'). We investigated the role of EPO and hepcidin, two key hormones involved in anaemia

Kinetics of serum hepcidin and interleukin-6 levels following COVID-19 infection in hemodialysis patients

International audiencePatients with chronic kidney disease (CKD), particularly those undergoing hemodialysis (HD), are at high risk of a severe form of coronavirus disease 2019 (COVID-19). Recently we showed that an elevated neutrophil: lymphocyte ratio at day 7 of COVID-19 predicted outcome in adult HD patients. Elevated serum C reactive protein (CRP) and ferritin were also hallmarks of the disease, confirming that, similar to all COVID-19 patients, hyperinflammation and iron disorder are also present in HD patients. Here we additionally explored hepcidin, the master regulator of iron homeostasis that has rarely been measured in COVID-19 and interleukin-6 (IL-6), the cytokine that stimulates hepcidin in inflammatory conditions

A mathematical model to predict BNP levels in hemodialysis patients

International audienceAim: Clinical interpretation of B-Type Natriuretic Peptide (BNP) levels in hemodialysis patients (HD) for fluid management remains elusive.Method: We conducted a retrospective observational monocentric study. We built a mathematical model to predict BNP levels, using multiple linear regressions. Fifteen clinical/biological associated with BNP variation were selected. A first cohort of 150 prevalent HD (from September 2015 to march 2016) was used to build several models. Thebest model proposed was internally validated in an independent cohort of 62 incidents HD (from March 2016 to September 2017).Results: In cohort 1, mean BNP Level was 630±717 ng/ml. Cardiac disease (CD = Stable Coronary Artery Disease and/or Atrial Fibrillation) was present in 45% of patient. The final model includes: Age, systolic Blood Pressure (sBP), Albumin, CD, Normo-hydrated Weight (NHW) and the Fluid Overload (FO) assessed by bio-impedancemetry. The correlationbetween the measured and the predicted log-BNP was 0.567 and 0.543 in cohort-1 and 2 respectively. Age (β=3.175e-2, p<0.00), CD (β=5.243e-1, p<0.001) and FO (β=1.227e-1, p<0.001) contribute the most significantly to the BNP level, respectively, but within a certain range. We observed a logistic relationship between BNP and age between 30 to 60 years, after which this relationship was lost. BNP level was inversely correlated with NHW independently of CD. Finally, our model allows us to predict the BNP level according to the FO.Conclusion: We developed a mathematical model capable of predicting the BNP level in HD. Our results show the complex contribution of age, CD and FO on BNP level

Utility of early, short psychological care for women who experience early miscarriage: protocol for the randomized, controlled MisTher trial

Abstract Background Around one in ten women will have a miscarriage in their lifetime. Miscarriage is often considered a trivial event by caregivers, but it is associated with a high burden of psychological morbidity, especially during the first 6 months. There is no validated psychological management strategy for women who have had a miscarriage. The MisTher study aims to evaluate the utility of early, short psychological care for women who have had early miscarriage, in terms of anxiety, depression and post-traumatic stress disorder. Methods This is a prospective, multicenter, randomized, controlled, superiority study. In total, 932 women who have experienced early miscarriage (spontaneous interruption of pregnancy prior to 14 weeks of gestation) will be randomly assigned to either the intervention or the control group. The intervention consists of 4 teleconsultations of 45 min with a psychologist. All women, regardless of their allocated group, will be encouraged to seek an early consultation with a general practitioner or midwife. The primary endpoint will be anxiety at 3 months after randomization evaluated using State Trait Anxiety Inventory. The secondary endpoints will be anxiety at 6 months evaluated using State Trait Anxiety Inventory, depression at 3 and 6 months evaluated with the Beck Depression Inventory, and post-traumatic stress disorder at 3 and 6 months, evaluated using the Posttraumatic stress disorder Checklist Scale. Discussion This project will validate the importance of early psychological management, based on primary care and accessible to most women, via teleconsultation, in reducing the frequency of psychological disorders after early miscarriage. Our results should provide a basis for new recommendations for the management of women who have experienced miscarriage, notably by recommending the involvement of trained psychologists in the management pathway for these women. Trial registration The trial is registered with ClinicalTrials.gov: NCT05653414. December 15th, 2022